How we do it–Prevention and Management of Hepatic Artery Thrombosis Following Liver Transplantation

Aims: The incidence of hepatic artery thrombosis (HAT) after liver transplantation (LTx) is ranging from 2.5–9% in adult recipients. HAT occurring early after LTx is associated with a substantial rate of graft loss and patient mortality. Methods: To minimize complication rates related to HAT, we developed an algorithm (Fig. 1) which we have routinely applied since 2001. Incidence and its related risk factors, outcome and possible therapeutic approaches of HAT were analyzed in prospectively non- controlled collected data from December 2001 to December 2006.

Results: There were 335 LTx in 299 adults (199 male, 100 female) with a median age of 49.7 (range: 18–68) years. HAT was defined as early and late HAT (diagnosis within or after 30 days following LTx). After a mean follow-up of 17 months (range: 4–30 months), nine HAT were documented (2.7%; five early and four late HAT). Treatment consisted of catheter directed thrombolysis (n=1), surgical thrombectomy (n=4), and retransplantation (n=4). Five HAT patients died during follow-up. Complex arterial reconstruction was associated with HAT compared to branch-patch anastomoses (P=0.0193). Median arterial intraoperative blood flow in HAT patients was 274.5 (range: 80–350)ml/min compared to 321 (range: 35–1300)ml/min in uncomplicated cases (not significant) and was no risk factor for HAT. One-year patient survival after HAT was 31%. Conclusion: Once HAT occurs, complication rates are high and long-term results are devastating. Therefore, we have implemented the presented algorithm which showed an acceptable HAT rate and confirmed that HAT is a rare but serious complication after LTx.

Arterial thrombosis - algorithm - liver transplantation